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- 肝穿会诊，山东烟台2
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| 姓 名： | ××× | 性别： | 年龄： | ||
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| 肉眼检查： | |||||
病理号566 ID51391
患者男性，25岁，无饮酒用药史，无家族肝病史，单位体检发现转氨酶异常住院。病原学检查：HBsAg(-),HBsAb(-),HBeAg(-),HBeAb(-),HBcAb(-);HEV-IgG(+);HEV-IgM(-);EB- IgM(-),CMA(-);自身抗体：ANA（+/-）,LKM（+/-）.
转氨酶：
| 日期 | ALT | AST | Tbil | D-bil | PTA | AKP | r-GT | A | G |
| 5.5 | 73 | 55 | 9.6 | 3.4 |
| 117 | 70 | 48 | 29 |
| 5.11 | 66 | 44 | 15.8 | 4.9 |
| 103 |
| 41.7 | 34.9 |
| 5.22 | 124 | 49 | 14.1 | 4.2 |
| 104 | 37 | 46.8 | 31.6 |
| 5.30 | 119 | 45 | 13.7 | 4.1 | 108 | 139 | 44 | 48.8 | 29 |
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×参考诊断
This liver biopsy shows at least bridging fibrosis. Not sure from memory, does Wilson's disease happen in Caucasians only, or also involve asians? How about hemosiderosis? Not much inflammation and not much steatosis, probably not caused by viral hepatitis or alcohol consumption. How about NASH, non-alcoholic steatohepatitis?
Not the typical PSC. PSC involves extrahepatic and intrahepatic biliary system and has typical radiographic findings. PBC (primary biliary cirrhosis) involves intrahepatic bile ducts and causes destruction and disapprearacne of bile ducts. I think i saw relative normal bile ducts on photos.
Working up the etiology of a liver disease is not easy and i am afraid a few on-line photos are far from sufficient.
Real "onion skin" like periductal fibrosis for PSC is much better developed than seen here.
